Increase Wellness and Decrease Burnout in Medical Students with Mindfulness
By John M. de Castro, Ph.D.
“training in mindfulness – focusing controlled attention on physical sensations, thoughts, and emotions in the present moment – helps students to acknowledge and process the stresses and strains of their work.” – Cathy Kerr
Stress is epidemic in the western workplace with almost two thirds of workers reporting high levels of stress at work. In high stress occupations, like healthcare, burnout is all too prevalent. Burnout is the fatigue, cynicism, emotional exhaustion, sleep disruption, and professional inefficacy that comes with work-related stress. It is estimated that over 45% of healthcare workers experience burnout. Currently, over a third of healthcare workers report that they are looking for a new job. It not only affects the healthcare providers personally, but also the patients, as it produces a loss of empathy and compassion. Burnout, in fact, it is a threat to the entire healthcare system as it contributes to the shortage of doctors and nurses.
Preventing burnout has to be a priority. Unfortunately, it is beyond the ability of the individual to change the environment to reduce stress and prevent burnout, so it is important that methods be found to reduce the individual’s responses to stress; to make the individual more resilient when high levels of stress occur. Contemplative practices have been shown to reduce the psychological and physiological responses to stress. Indeed, mindfulness has been shown to be helpful in treating and preventing burnout, increasing resilience, and improving sleep. It would be best to provide techniques to combat burnout early in a medical career. Medical School is extremely stressful and many students show distress and express burnout symptoms. Medical school may be an ideal time to intervene.
In today’s Research News article “A Targeted Mindfulness Curriculum for Medical Students During Their Emergency Medicine Clerkship Experience.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6040904/ ), Chung and colleagues in an uncontrolled pilot study delivered a mindfulness curriculum to students during their training in emergency medicine. The training was delivered in 4-weekly 60 minute sessions that included meditation practice, readings, journaling, discussion, and developing a personal wellness plan. They completed questionnaires before and after the 4 weeks of training and 6 months later regarding the impact of the training on their behavior and attitudes.
They found that in comparison to baseline, after training there were significant improvements in self-reported behaviors and attitudes. The students reported increased confidence in their ability to meditate and be mindful, explain these skills to others, and recommend these practices to others. They also reported that they practiced meditation and mindfulness more often and talked to others about these practices. In addition, they reported that wellness was important to medical students and that they were using their own wellness plan. Importantly, these improvements were still present 6 months after the completion of the training.
These are very preliminary results from an uncontrolled pilot study and need to be verified in a randomized controlled trial with objective measures of wellness and resistance to stress. Previous controlled studies, however, have shown that mindfulness training is effective in treating and preventing burnout and reducing the psychological and physiological responses to stress. So, these present results are suggestive that this simple brief curriculum may produce similar benefits.
It is important to use a brief training and this one only involved 4 hours of formal instruction. Medical students have a vast amount of important information to learn and master in a limited amount of time. They do not have the luxury of unused time for extensive instruction. So, a brief training that produces positive results that persist could be very valuable to their health and well-being during this stressful time and during a stressful career.
So, increase wellness and decrease burnout in medical students with mindfulness.
“I have taken my own advice. I am still at it: sitting on the deck, focusing on my breath, watching my thoughts, clearing my mind amid the shrill end-of-summer calls of the cicadas. I think I have noticed an effect — I feel a deeper sense of acceptance in my life, without losing a passion or resolve to change things for the better.” – Manoj Jain
CMCS – Center for Mindfulness and Contemplative Studies
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Chung, A. S., Felber, R., Han, E., Mathew, T., Rebillot, K., & Likourezos, A. (2018). A Targeted Mindfulness Curriculum for Medical Students During Their Emergency Medicine Clerkship Experience. The western journal of emergency medicine, 19(4), 762-766.
Despite high rates of burnout in senior medical students, many schools provide the majority of their wellness training during the first and second preclinical years. Students planning a career in emergency medicine (EM) may be at particularly high risk of burnout, given that EM has one of the highest burnout rates of all the specialties in the United States We developed an innovative, mindfulness-based curriculum designed to be integrated into a standard EM clerkship for senior medical students to help students manage stress and reduce their risk of burnout.
The curriculum included these components: (1) four, once-weekly, 60-minute classroom sessions; (2) prerequisite reading assignments; (3) individual daily meditation practice and journaling; and (4) the development of a personalized wellness plan with the help of a mentor. The design was based on self-directed learning theory and focused on building relatedness, competence, and autonomy to help cultivate mindfulness.
Thirty students participated in the curriculum; 20 were included in the final analysis. Each student completed surveys prior to, immediately after, and six months after participation in the curriculum. We found significant changes in the self-reported behaviors and attitudes of the students immediately following participation in the curriculum, which were sustained up to six months later.
Although this was a pilot study, our pilot curriculum had a significantly sustained self-reported behavioral impact on our students. In the future, this intervention could easily be adapted for any four-week rotation during medical school to reduce burnout and increase physician wellness.